Epidural steroid injections are most effective at treating pain in the following areas:
- Lumbar spine (low back) with or without leg symptoms
- Cervical spine (neck) with or without arm symptoms
- Thoracic spine (midback) – this is less common
Before undergoing an ESI, you should pursue more conservative solutions such as:
- Physical therapy
- Medications
- Activity modification
Six weeks is often quoted as a reasonable timeframe to try these more conservative approaches before consideration of an ESI. However, in cases of severe or debilitating pain, or neurological signs or symptoms, an earlier ESI is reasonable and often very helpful.
During your initial consultation, your provider will review your medical history and imaging, and perform a physical examination. If we believe an ESI is the right treatment approach for you, we will discuss the procedure in detail so that you understand what is involved before moving forward.
It is important to note that while the ESI can provide pain relief, rehabilitation with physical therapy will still be necessary in most cases. You should be able to be more successful with your rehabilitation efforts while taking advantage of the pain relief provided by the ESI.
Clinical research has shown that ESIs can, in many cases, provide significant relief of pain on the order of weeks to months, or possibly more long-term. They can not only reduce the chances of needing surgery, ESIs also provide relief for enough time to allow you to progress through a rehabilitation program and improve your level of function.
If the ESI provides some duration of pain relief but symptoms return, a second injection may be considered in the following cases:
- The first ESI provided significant, though partial, relief. The goal would be to eliminate the remaining pain
- The first ESI provided substantial relief that lasted several days, weeks, or months and the pain begins to return
The decision to proceed with a second or third injection is made in consultation with your spine care provider. It is usual to wait two weeks or more between injections.
